Echocardiography was initially developed in the mid-20th Century and its adoption in the subsequent decades has strongly influenced how clinicians are trained and how they subsequently perform cardiac examinations of patients. A readily available, non-invasive method of imaging the beating heart that could provide critical reinforcement of what was heard through the stethoscope should have enhanced physical examination skills, but in fact the opposite has happened. Cardiac examination skills have declined since the advent of echocardiography, a function of overreliance on technology and the present healthcare environment that emphasizes rapid delivery of care. Several decades ago, patients' hospital stays were long, providing trainees and their instructors frequent opportunities for bedside teaching rounds. Today, hospital admissions are short and intensely focused, with fewer opportunities for trainees to learn and practice bedside examination skills Attending physicians, having been trained in this environment, further amplify the problem if their own cardiac examination skills are not well developed. In the absence of bedside training with patients, audio recordings of heart sounds has served as a poor substitute, and as a result clinicians now commonly close their eyes while conducting cardiopulmonary examination, shutting out important visual and palpable cues exhibited by the patient. Multicenter studies of cardiac examination skills document a rise in test scores until the third year of medical school, but no further improvement thereafter despite years in residency training, or even further years in practice. (See, e.g., Arch Intern Med (166):610-617, (2006) and Clin Cardiol (33;12):738-745 (2010)) Indeed, full-time internal medicine professors perform no better in tests of cardiac examination skills than the third-year medical students they teach. Compounding the problem is a lack of critical reinforcement when auscultating patients. Critical reinforcement implies a commitment to confirming or refuting one's bedside diagnostic impressions by critical review and correlation with available imaging and/or hemodynamic studies performed on that patient. Unfortunately, patient exposure without critical reinforcement seems to be the norm for the average medical resident, explaining their lack of advancement in examination skills despite clinical encounters with hundreds of patients.